Hundred year old institution to provide culturally relevant palliative care in modern-day Ethiopia

Categories: Community Engagement.

An ‘iddir’ is an Ethiopian financial and social institution, with its main function being to support its members during bereavement. They were first founded in Addis Ababa by migrants in the early twentieth century.[1]

When a fellow iddir member dies, female members are often involved in food preparation for relatives, friends and neighbours of the deceased as they meet together.

Male members provide practical help in procuring a tent and chairs so that people can sit and grieve together. The tent provides the necessary room for all the visitors, as often a relative’s home is not large enough. This bereavement ceremony takes place over several days and is known as a ‘luxo’, which comes from the Amharic word ‘to cry’[2].

In more recent years, the role of the iddir has expanded; an example of this is the successful role iddirs have played in providing support and care for patients living with HIV/AIDS in the height of the AIDS pandemic[3].

However, the palliative care needs in Ethiopia are more complex than just HIV/AIDS due to the increasing incidence of patients with cancer and non-communicable diseases. Therefore, Hospice Ethiopia is working with iddirs in a new and innovative way to provide culturally relevant palliative care awareness and referral using these century old institutions.

Hospice Ethiopia works firstly with local iddir members to create awareness about palliative care and Hospice Ethiopia services. After creating awareness, iddir members are then able to refer patients from the community to Hospice Ethiopia services which include home care, out-patient clinics, day care and bereavement services.

The Worldwide Hospice Palliative Care Alliance (WHPCA) and Hospice Ethiopia are working on a project to promote a culturally relevant palliative care delivery that is home and community-based with support from iddirs. 

The iddirs will serve as the community mechanism supporting home and community-based care and for mobilising community volunteers. They will play active roles in advocating for more support, including access to pain medications from the government and other organisations[4].

The mobilisation of iddirs will be supported by three major activities. These are: a) recruitment of community volunteers, b) training of student nurses on their final year, c) linking three hospitals in Addis Ababa for referrals.

The project will benefit 588 adults and 10 children with cancer HIV & AIDS, and other life-limiting illnesses in Addis Ababa. 

30 Community volunteers and 100 student nurses on their final year will be trained to provide support and referrals for those in need. Approximately 5,000 people will benefit from referrals to various health facilities by the student nurses. The project will provide much needed assistance to at least 1,176 family members responsible for caring for their chronically ill relatives.

Benefits of the project will include: Improvement in health and well-being among beneficiaries, an increase in support to home and community-based care by iddirs, an icrease in voluntarism among community members and referrals from students nurses, and increased awareness of and access to treatment to hospitals and health facilities including cancer treatment and voluntary counselling and testing.

Watch ehospice for updates on this important and innovative project. Find out more about the WHPCA and Hospice Ethiopia on their respective websites.

References  

[1] Ayers, N. (2014) ‘Not Wanting to Upset’: The Management of Emotions in Caring for the Dying. An Ethnographic Study in Addis Ababa, Ethiopia (unpublished thesis) Surrey University, UK.

[2] Pankhurst, A. and Haile Mariam, D. (2000) ‘The Iddir in Ethiopia: Historical Development, Social Function, and Potential Role in HIV/AIDS Prevention and Control’ Northeast African Studies. (2) pp. 35-57..

[3] Wube, M., Horne, C. J. and Stuer, F. (2010) ‘Building a Palliative Care Program for Ethiopia: the impact on HIV and AIDS patients and their families’, Journal of Pain and Symptom Management. 40, (1) pp.6-8.

[4] WHPCA Capacity Statement 2015